Folafoluwa O Odetola1, Susan L Bratton. 1. Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine , University of Michigan Medical School and University Health System, Ann Arbor, MI 48109, USA. fodetola@med.umich.edu
Abstract
OBJECTIVE: To describe patient characteristics, use of technology and mortality in children with meningitis admitted to the pediatric intensive care unit (PICU). DESIGN: Retrospective cohort study. SETTING: Fifteen US PICUs. PATIENTS: All admissions with a diagnosis of meningitis between 1995 and 2000 in the Pediatric Intensive Care Unit Evaluations (PICUEs) database. MEASUREMENTS AND RESULTS: Of 559 patients with meningitis, 58% were male. The median age was 19 months and the median length of PICU stay was 2 days. The crude PICU mortality rate was 7%. Three hundred thirty-four (60%) patients had bacterial meningitis. Non-survivors had significantly higher Pediatric Risk of Mortality (PRISM) III scores and also constituted a larger proportion of the patients with bacterial meningitis, coma and shock upon PICU admission. The use of invasive devices was higher among non-survivors, patients with bacterial meningitis or those who were in coma or shock upon PICU admission. There was significant variation in the use of intracranial pressure (ICP) monitors by coma status and by institution. In multivariate analysis, patients had 1.26 higher odds of mortality for each unit increase in PRISM III score (odds ratio 1.26, 95% confidence interval: 1.19-1.34), while adjusting for other variables. CONCLUSION: In a large cohort of children admitted to the PICU with meningitis, severity of illness, particularly the presence of shock or coma, was significantly associated with both the higher use of invasive medical devices and higher mortality. There was significant variation in the use of ICP monitors among the various PICUs without statistical association with survival.
OBJECTIVE: To describe patient characteristics, use of technology and mortality in children with meningitis admitted to the pediatric intensive care unit (PICU). DESIGN: Retrospective cohort study. SETTING: Fifteen US PICUs. PATIENTS: All admissions with a diagnosis of meningitis between 1995 and 2000 in the Pediatric Intensive Care Unit Evaluations (PICUEs) database. MEASUREMENTS AND RESULTS: Of 559 patients with meningitis, 58% were male. The median age was 19 months and the median length of PICU stay was 2 days. The crude PICU mortality rate was 7%. Three hundred thirty-four (60%) patients had bacterial meningitis. Non-survivors had significantly higher Pediatric Risk of Mortality (PRISM) III scores and also constituted a larger proportion of the patients with bacterial meningitis, coma and shock upon PICU admission. The use of invasive devices was higher among non-survivors, patients with bacterial meningitis or those who were in coma or shock upon PICU admission. There was significant variation in the use of intracranial pressure (ICP) monitors by coma status and by institution. In multivariate analysis, patients had 1.26 higher odds of mortality for each unit increase in PRISM III score (odds ratio 1.26, 95% confidence interval: 1.19-1.34), while adjusting for other variables. CONCLUSION: In a large cohort of children admitted to the PICU with meningitis, severity of illness, particularly the presence of shock or coma, was significantly associated with both the higher use of invasive medical devices and higher mortality. There was significant variation in the use of ICP monitors among the various PICUs without statistical association with survival.
Authors: François G Brivet; Sophie Ducuing; Frédéric Jacobs; Isabelle Chary; Roger Pompier; Dominique Prat; Bogdan D Grigoriu; Patrice Nordmann Journal: Intensive Care Med Date: 2005-10-22 Impact factor: 17.440
Authors: Peter Andrews; Elie Azoulay; Massimo Antonelli; Laurent Brochard; Christian Brun-Buisson; Geoffrey Dobb; Jean-Yves Fagon; Herwig Gerlach; Johan Groeneveld; Jordi Mancebo; Philipp Metnitz; Stefano Nava; Jerome Pugin; Michael Pinsky; Peter Radermacher; Christian Richard; Robert Tasker Journal: Intensive Care Med Date: 2006-02-18 Impact factor: 17.440
Authors: Jean-Louis Vincent; Simon Nadel; Demetrios J Kutsogiannis; R T Noel Gibney; S Betty Yan; Virginia L Wyss; Joan E Bailey; Carol L Mitchell; Samiha Sarwat; Stephen M Shinall; Jonathan M Janes Journal: Crit Care Date: 2005-05-17 Impact factor: 9.097